Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial

Korfage, Ida J.; Carreras, Giulia; Arnfeldt Christensen, Caroline M.; Billekens, Pascalle; Bramley, Louise; Briggs, Linda; Bulli, Francesco; Caswell, Glenys; ?erv, Branka; Van Delden, Johannes J. M.; Deliens, Luc; Dunleavy, Lesley; Eecloo, Kim; Gorini, Giuseppe; Groenvold, Mogens; Hammes, Bud; Ingravallo, Francesca; Jabbarian, Lea J.; Kars, Marijke C.; Kodba-?eh, Hana; Lunder, Urska; Miccinesi, Guido; Mimi?, Alenka; Ozbi?, Polona; Payne, Sheila A.; Polinder, Suzanne; Pollock, Kristian; Preston, Nancy J.; Seymour, Jane; Simoni?, Anja; Johnsen, Anna Thit; Toccafondi, Alessandro; Verkissen, Mari�tte N.; Wilcock, Andrew; Zwakman, Marieke; Van Der Heide, Agnes; Rietjens, Judith A. C.

Abstract

Background: Advance care planning (ACP) supportsindividuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomized clinical trials of ACP in patients with advanced cancer are scarce.

Methods and findings: To test the implementation of ACP in patients with advanced cancer we conducted a cluster-randomized trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, United Kingdom in 2015-18. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least three months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm, included scripted ACP conversations between patients, family members and certified facilitators; standardized leaflets and standardized advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalized as European Organization for the Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, advance directives inclusion in hospital files, and use of hospital care.

1,117 patients were included (442 intervention; 675 control), 809 (72%) completed the 12 weeks questionnaire. Patients’ age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients’ quality of life did not differ between intervention and control groups (T-score -1.8 vs. -0.8, p=0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p=0.002) and advance directives inclusion in hospital files (10% versus 3%, p

• Journal Article Type: Article
• Acceptance Date: Oct 20, 2020
• Online Publication Date: Nov 13, 2020
• Publication Date: Nov 13, 2020
• Deposit Date: Oct 23, 2020
• Publicly Available Date: Nov 13, 2020
• Journal: PLOS Medicine
• Print ISSN: 1549-1277
• Electronic ISSN: 1549-1676
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 11
• Article Number: e1003422
• DOI: https://doi.org/10.1371/journal.pmed.1003422
• Keywords: General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/4984428
• Publisher URL: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003422